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Federal and state governments, including Missouri, have been engaged in
a series of activities to improve the availability of patient data in electronic
format. One such activity is the creation of the Medicaid and Medicare electronic
health record (EHR) incentive programs. These incentives will be in the form
of yearly payments, beginning in 2011, to help a broad range of health care
professionals and hospitals implement and meaningfully use EHRs. The following
FAQ describes incentive payment eligibility, program requirements, payments,
Missouri resources, and other relevant details. This information will be
updated as policy and program decisions are made at both the federal and state
level.

General Program Questions

MO HealthNet plans to make enrollment available early in 2011. In order
to launch the program, MO HealthNet must receive approval from the Centers
for Medicare and Medicaid Services (CMS). MO HealthNet anticipates receiving
this approval in late 2010 or early 2011.

CMS requires all states implementing the Medicaid EHR Incentive Program
to prepare a State Medicaid Health IT Plan (SMHP). Primarily a technical
document, the SMHP describes MO HealthNet’s approach to EHR Incentive Program
implementation. The final version submitted to CMS for review is posted
on the MO HITECH website and can be accessed at http://dss.mo.gov/mhd/general/pdf/draftsmhp102010.pdf.
Once Missouri has received CMS approval of its SMHP, this FAQ will be updated
to reflect final program policies and procedures.

Eligibility for Medicare and Medicaid EHR incentives is based, in part,
on using certified EHR technology. The Office of the National Coordinator
for Health Information Technology (ONC) has developed a process to certify
EHR vendors and products. The list of certified products can be viewed
here: http://onc-chpl.force.com/ehrcert.

The Centers for Medicare and Medicaid Services (CMS) has a broad range
of information available on its website (e.g., federal eligibility requirements,
meaningful use, payment process, etc.): https://www.cms.gov/EHRIncentivePrograms/.

Program Eligibility

In Medicaid, eligible professionals (EPs) include physicians, dentists,
certified nurse midwives, nurse practitioners; physician assistants practicing
in rural health clinics or Federally-Qualified Health Centers (FQHCs) led
by a physician assistant are also eligible. EPs must have at least a 30%
patient volume attributable to Medicaid (20% for pediatricians). MO HealthNet
has proposed that EPs have the flexibility to base their volume on either
(1) the EP’sindividual Medicaid patient encounters as
a percentage of the EP’s total encounters or (2) the practice’stotal Medicaid
encounters as a percentage of the practice’s total patient encounters.
MO HealthNet must receive approval from the Centers for Medicare and Medicaid
Services (CMS) before this approach is finalized.

Yes. EPs working in FQHCs or RHCs may meet the 30% volume requirement
through a combination of Medicaid and “needy individual” encounters. Needy
individual encounters are those encounters funded in part or in whole by
MO HealthNet, MO HealthNet for Kids, uncompensated care or patient payment
based on a sliding scale.

No.Hospital-based physicians do not qualify for the
EHR incentive program. Hospital-based physicians are defined as those furnishing
substantially all (90%) professional services in a hospital or emergency
department setting. Eligible professionals who practice in hospital-owned
outpatient clinics qualify for the incentive program provided they meet
all other program criteria.

No. Nursing homes are not eligible. Under Medicaid, the only eligible
institutional providers are acute care hospitals, stand-alone children’s hospitals, cancer hospitals, and critical access hospitals. Eligible Professionals
may choose to assign incentive payments to their employer. Therefore, if
an Eligible Professional employed by a nursing home met the criteria, s/he
could choose to assign their payment to their employer.

The Centers for Medicare and Medicaid Services plays a central role in
administering both incentives. Regardless of whether an EH or EP chooses
Medicare or Medicaid incentives, they will be required to enroll through
the National Level Repository (NLR). The NLR is still being developed and
is not currently accessible.

Once the NLR information is entered, EPs will select either the Medicare
or Medicaid incentives. If an EP chooses the Medicaid incentives, additional
information must be given to MO HealthNet. This process will happen via
the MO HealthNet website. Specific details of the MO HealthNet program
are under development; updates will be provided as they are available.

Incentive Payments

According to federal guidelines, Medicare incentive payments will begin
May 2011. This date assumes that eligible professionals (EPs) and eligible
hospitals (EHs) have submitted all the appropriate information and met
all eligibility and reporting requirements, and that Missouri’s program
has been approved by CMS Missouri is engaged in considerable planning efforts
in order to coordinate the EHR Incentive Program with other State and Federal
health IT activities and will post additional information about program
launch as it becomes available.

No. Eligible professionals (EPs) may only receive an EHR incentive
payment under either Medicare or Medicaid in a given year. EPs can switch
programs one time only between the time the program begins
and 2014. Eligible hospitals can receive incentives under both
programs.

Medicaid eligible professionals (EPs) may receive up to $63,750
over six years (2011 through 2021). For the first payment year, Medicaid
EPs can receive up to $21,250 for the initial adoption, implementation
or upgrade of certified EHR technology. In subsequent years, Medicaid EPs
can receive up to $8,500 annually for costs related to operation, maintenance
and demonstration of meaningful use of EHR technology.

Eligible professionals (EPs) can receive up to $44,000 over four years
(2011 through 2015). The payment is equal to 75% of Medicare allowable
charges for covered services furnished by the EP in a year (maximum payment
in the first, second, third, fourth, and fifth years of $15,000; $12,000;
$8,000; $4000; and $2,000, respectively). Early adopters (EPs whose
first payment year is 2011 or 2012) can receive a maximum payment of $18,000
in the first year. For EPs who predominantly furnish services in a health
professional shortage area (HPSA), Medicare incentive payments would be
increased by 10%.

No. By law, the EHR Incentive Program does not provide for incentive
payments beyond the already-established limits, regardless of EHR system
costs. The purpose of the payments is to encourage the adoption and meaningful
use of certified EHR technology, rather than to reimburse fully for such
activities.

Forthose receiving Medicare incentives, CMS will post
the list of names online. The list will include elements identified in
the originating legislation (name, business address, and business phone
number for all Medicare eligible professionals and hospitals who received
incentive payments). There is no requirement to publish the names of those
receiving Medicaid incentive payments, although States may opt to do so.

No up-front funding is provided. In Medicare, incentives are
only available after EPs demonstrate meaningful use. This demonstration
will require reporting on activities over a contiguous 90-day period. In Medicaid,
providers can receive some funding before demonstrating meaningful use,
provided they can demonstrate steps to adopt, implement or upgrade their
certified EHR technology.

Through 2016, eligible professionals (EPs) can receive a one-time incentive
payment for 85% of net average allowable costs (not to exceed $25,000)
for the purchase and initial implementation or upgrade of a certified EHR
technology. After acquiring an EHR and receiving the first payment, EPs
can then receive incentive payments for up to 5 years (but not beyond 2021)
for the net average allowable costs to operate, maintain, and use their
EHR (allowable cap per year is $10,000) if they meet the definition of
a meaningful EHR user. More information on meaningful use is provided in
the meaningful use section of this FAQ.

There are several key differences. The first is that only providers with
at least a 30% Medicaid patient volume (20% for pediatricians) qualify
for the Medicaid incentives. Second, payments for the Medicaid program
are up to a maximum of $63,750 while in Medicare, the maximum is $44,000.
Finally, in Medicaid, payments are for actual upfront purchase and ongoing
maintenance costs. By contrast, Medicare payments are made as a percentage
of Medicare charges rather than the actual purchase and maintenance costs.

No. Eligible Professionals (EPs) may voluntarily assign their incentive
payment to their employer. This is likely to be most common in environments
where the employer paid for most or all of the certified EHR technology.
The Centers for Medicare and Medicaid Services (CMS) views the assignment
process as primarily a contractual issue between employer and employee.
As such, there is a limited involvement by the federal government or by
MO HealthNet

Meaningful Use

CMS has outlined a number of HIT functional and clinical quality measures
that must be met in order to be deemed a meaningful user (additional meaningful
use information can be found on the CMS website: http://www.cms.gov/EHRIncentivePrograms/110_Meaningful_Use.asp#TopOfPage).

HIT functional measures are as follows:

15 core measures (eligible professionals)

14 core measures (eligible hospitals)

Both eligible professionals and eligible hospitals must then choose
5 of 10 HIT functional measures from a “menu”

Eligible professionals must choose at least 1 “menu” measure that addresses
public health

CMS rules require eligible professionals (EPs) and eligible hospitals
(EHs) to report on any continuous 90-day period within a payment year in
which an EP or EH successfully demonstrates meaningful use of certified
EHR technology. This meaningful use reporting period began on October 1,
2010 for Medicare EHs. There is no reporting period associated with the
Adopt, Implement or Upgrade (AIU) component of the Medicaid EHR
Incentive Program. This means that EPs who choose to receive incentives
based on AIU criteria, rather than meaningful use, would be required to
attest to their efforts to adopt, implement or upgrade Certified EHR Technology.
CMS has indicated that documentation to support the attestation must be
binding in nature (e.g., a signed contract, invoice, etc.). MO HealthNet
will provide more specific examples of acceptable documentation closer
to program launch.

Penalties

For Medicare, physicians who are not “meaningful”
EHR users will see a 1% reduction in payment starting January 1, 2015.
The reduction increases to 2% in 2016 and 3% in subsequent years. Hardship
exceptions may be issued on a case-by-case basis, such as exceptions for
physicians who practice in rural areas without adequate Internet access.
There are no Medicaid penalties.

Yes. There is no requirement that providers participate in either the
Medicare or Medicaid Incentive Program. Providers can opt out but will
receive a reduction in Medicare payment if they do not meet meaningful
use standards by 2015.

Missouri Resources

No. Any EHR must meet federal certification guidelines. On August 11,
2010, the Office of the National Coordinator for Health Information Technology
(ONC) released temporary certification guideline. EHR vendors wishing to
become certified must go through an established process to get this temporary
certification. More information the process, guidelines, and additional
certification issues is available here: http://healthit.hhs.gov/portal/.

The Missouri HIT Assistance Center is a federally-funded resource center
charged with assisting providers with EHR implementation. In particular,
the Center must target services to solo and small primary care providers,
rural providers, community clinics and critical access hospitals. The Center
has negotiated group purchasing arrangements with selected vendors. More
information is available here: http://www.assistancecenter.missouri.edu/.